Organization
GRIESEMER CHIROPRACTIC, LLC
Active
Other names
Greenwood Pain Management
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK THOMAS GRIESEMER D.C. (DOCTOR, MEMBER, MANAGER)
(317) 884-4400
Entity
Organization
Contact information
Practice address
223 S STATE ROAD 135, GREENWOOD, IN 46142-1421
(317) 881-9792
(317) 882-1766
Mailing address
223 S STATE ROAD 135, GREENWOOD, IN 46142-1421
(317) 881-9792
(317) 882-1766
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
08001713
IN
207Q00000X
Family Medicine Physician
01068922A
IN
208VP0014X
Interventional Pain Medicine Physician
Primary
01053184A
IN
261QM1300X
Multi-Specialty Clinic/Center
—
—
363A00000X
Physician Assistant
10000648A
IN
363AM0700X
Medical Physician Assistant
10002090A
IN
363LF0000X
Family Nurse Practitioner
71005986A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000207597
ANTHEM
IN
01
—
08001713
LICENSE
IN
05
—
200223900
—
IN
01
—
350053496
RAILROAD MEDICARE
—
01
—
7165004
AETNA
—
Enumeration date
10/05/2007
Last updated
07/26/2017
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